Provider Demographics
NPI:1932273166
Name:OTTEN, DEBRA LYNN (APRN BC FAMILY NURSE)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:LYNN
Last Name:OTTEN
Suffix:
Gender:F
Credentials:APRN BC FAMILY NURSE
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:LYNN
Other - Last Name:HEALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:18650 YORKSHIRE LANE
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045
Mailing Address - Country:US
Mailing Address - Phone:262-781-2192
Mailing Address - Fax:
Practice Address - Street 1:1801 DOLPHIN DR
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186
Practice Address - Country:US
Practice Address - Phone:262-953-8566
Practice Address - Fax:262-446-0388
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1342033363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily